26例足月新生儿胃穿孔临床特征的回顾性研究

Neonatal gastric perforation in 26 full-term infants: a retrospective cohort study

摘要:

目的 分析足月新生儿胃穿孔（neonatal gastric perforation，NGP）的临床特征，为减少不良临床结局提供依据。方法 纳入2009年1月至2020年10月重庆医科大学附属儿科医院确诊为胃穿孔的住院足月新生儿，收集患儿的临床表现、治疗方案及出院后3个月内短期预后情况，分析临床特征。结果 26例确诊胃穿孔的足月儿纳入研究。男性多于女性（88.5% vs. 11.5%），中位入院年龄及发病年龄为分别为94.5（48.0，135.0）h及38.0（0.0，96.0）h。伴随临床表现中，以腹胀（69.2%）、呕吐（46.2%）和反应低下（30.8%）为主要表现。以血培养屎肠球菌（15.0%）、腹腔穿刺液培养溶血葡萄球菌（30.8%）为主，且2种培养结果的阴性率均高（55.0%、23.1%）。25例（96.2%）行腹部平片，21例（84.0%）检出气腹征象；9例（34.6%）行腹部超声，均无气腹征象，以腹水征象为主（88.9%）。胃穿孔部位最常见为胃底部（61.6%），以单发部位穿孔（92.3%）为主。18例（69.2%）行病理检查，以胃壁充血出血伴坏死（66.7%）为主。所有病例均接受急诊手术治疗，其中以胃穿孔修复+腹腔引流术为主（53.9%）。出院后3个月内随访，24例（92.3%）术后恢复良好，仅1例（3.9%）因最终拒绝再次手术，并放弃治疗后死亡。结论 足月NGP好发于男性及生后4 d内，当出现腹胀、呕吐及反应低下表现，需及时完善腹部平片检查了解有无气腹征象，若能及时手术，短期预后良好。

Abstract:

Objective To analyze the clinical features of neonatal gastric perforation（NGP）in full-term infants，to reduce the occurrence of clinical adverse outcomes.Methods Full-term infants diagnosed with gastric perforation in Children’s Hospital of Chongqing Medical University from January 2009 to October 2020 were included in the study. The data of the infants including clinical manifestations，treatment options and short-term outcomes during three months after discharge from hospital were collected，and the clinical characteristics were retrospectively investigated.Results A total of 26 full-term infants diagnosed with gastric perforation were included in the study. The rate of male was significantly higher than that of female among these cases（88.5% vs. 11. 5%）. The median age at admission and onset were 94.5（48.0，135.0） h and 38.0（0.0，96.0）h. Among the accompanying clinical manifestations，abdominal distension（69.2%），vomiting（46.2%）and poor response（30.8%） were the main manifestations. The main positive pathogen in blood culture was in Enterococcus faecium（15.0%） and Staphylococcus haemolyticus（30.8%） was the first positive pathogen in peritoneal puncture fluid culture，while the negative rates of both the cultures were high（55.0% and 23.1%）. There were 25 cases（96.2%） who underwent abdominal plain film examination and 21 cases（84.0%） showed signs of pneumoperitoneum. Abdominal ultrasonography was performed in 9 cases（34.6%），and no one was found pneumoperitoneum signs but with mainly ascites signs（88.9%）. The most favorite site of gastric perforation was the fundus of the stomach（61.6%），with single site perforation（92.3%） as the main site. Eighteen cases（69.2%） underwent pathological examination，and the majority（66.7%） was hyperemia and hemorrhage associated with necrosis of gastric wall. All cases were treated by emergency surgery，mainly taking gastric perforation repair and abdominal drainage（53.9%）. Follow-up within 3 months after discharge showed that a total of 24 cases（92.3%） recovered well after surgery，and only 1 case（3.9%） died after discharge due to refusal of reoperation and abandonment of treatment.Conclusion NGP usually occurs in males and within 4 days after birth. Infants with performance for abdominal distention，vomiting and poor response should be timely examined by abdominal plain film to discover whether there are signs of pneumoperitoneum. If timely operation can be performed，short-term prognosis of NGP is good.